Gradual or Graded Exposure (Wolpe, 1957), is a commonly used strategy to support people to overcome a range of difficulties, often anxiety-based.  It involves a gradual move towards the task which is the hardest and is an effective strategy for EBSA as it supports children and young people to move slowly towards a school return.  Individual steps need to be small, actions for the plan are ranked in terms of difficulty and timescales for success are built in.  Plans for gradual exposure should be created in partnership with the family and team around the young person.

An example of a graded exposure approach is a stepped approach or an exposure ladder, where small steps are specified that to allow for success to be acknowledge and celebrated along the way.  An example of a stepped-approach, using graded exposure is shown in Figure Seven.

The key to the graded exposure plan is persistence and flexibility. Each success should be recorded and acknowledged.  Setbacks are expected and part of the process, so resilience and tenacity from everyone around the young person is crucial.  It is important to support the young person but equally important to challenge and push them to succeed in the next step of their journey. This is only possible if they have positive relationships with their key adult.  Someone they can trust, who will be there to help them manage their anxieties throughout the process.

Children and young people need the security of knowing that a graded exposure plan will be followed accurately.  It is therefore critically important that practitioners follow up on exactly what has been agreed, even if things seem to be going well.  Changing expectations or agreed actions will only increase their anxiety and risk their disengagement.  Effective communication and coordination is critical to ensure that all relevant people are informed and aware of the plan.  This will increase the young person’s chances of experiencing success.  The Case Study in Appendix I gives an insight into what can be required for this strategy to be a success.

Graded Exposure Simple Example